waiting times – Page 4 – The NEN

Call for increased investment in mental health as child referrals increase by more than 25%

The Scottish Children’s Services Coalition (SCSC), an alliance of leading providers of children’s services, has called for greatly increased investment in mental health services as the impacts of the Covid-19 pandemic on the young become clearer.

The call comes as new figures published by Public Health Scotland today (15^th March 2022), indicate that at the end of December 2021, 10,021 children and young people had been referred for treatment from specialist child and adolescent mental health services (CAMHS).

This includes issues such as anxiety and depression and represents a staggering 27.1 per cent increase from the previous quarter (July to September 2021) when the figure was 7,882.

With already under-resourced and overstretched services facing overwhelming pressure due to increased demand, the SCSC has raised concerns over a potential “lost generation” of vulnerable children and young people whose mental health is being impacted by Covid-19.

Even prior to the pandemic cases of poor mental health were at unprecedented levels and in crisis, and there are a growing number of vulnerable children who cannot access adequate support. The pandemic has exacerbated this, leading to unprecedented demand and backlogs, with services struggling to keep up.

In total, 4, 544 children and young people started treatment at CAMHS over the period October to December 2021. This is an increase of 19.8 per cent from the previous quarter (3,792) and only 70.3 per cent were seen within the Scottish Government’s waiting time target for the NHS of 18 weeks from referral to treatment (met by at least 90 per cent of patients).

This is a fall from the previous quarter when the figure was 78.6 per cent. Eight out of 14 health boards failed to meet this target.

A total of 1,570 children and young people had been waiting over a year for treatment at the end of December 2021.

In addition to increased investment in specialist CAMHS, the SCSC has called for greater workforce planning and a renewed focus on expanded prevention and early intervention services, reducing the need for referral to costly specialist mental health services.

It has also called for greater partnership working between the public, private and third sectors as well as greater awareness of the services on offer, especially those at a community level.

A spokesperson for the SCSC commented: “For some time now, we have raised concerns over a potential lost generation of vulnerable children and young people, whose mental health is being impacted even further by the Covid-19 pandemic.

“Too many of our young people are waiting too long for the treatment they need and it is more important than ever that children can access the support required, irrespective of where they live.

“While we welcome the attention that the Scottish Government has given to date on this vital issue, a lack of resources and lack of staff mean it’s becoming an impossible situation to manage. There must be a radical transformation of our mental health services, investing in specialist services and with a focus on preventing such problems arising in the first place and intervening early.

“This is a crisis we can overcome, but as the country comes to terms with the biggest hit to its mental health in generations, it will require a similar energy and commitment to that demonstrated for Covid-19 if we are to achieve this and prevent many young people giving up on their futures.”

Waiting times (with adjustments) for people who started their treatment from October to December 2021, by NHS Board of treatment:

Health board	Total number seen	% seen within 18 weeks
NHS Scotland	4,544	70.3
NHS Ayrshire & Arran	350	93.7
NHS Borders	70	67.1
NHS Dumfries & Galloway	133	47.4
NHS Fife	363	71.9
NHS Forth Valley	111	57.7
NHS Grampian	372	95.2
NHS Greater Glasgow & Clyde Valley	1,561	57.7
NHS Highland	232	75.0
NHS Lanarkshire	239	69.5
NHS Lothian	726	65.2
NHS Tayside	329	93.0
NHS Island Boards	58	100.0

Emergency Departments continue to face severe pressures as RCEM calls for meaningful action

The latest A&E activity and waiting times for major Emergency Departments in Scotland for January 2022 show:

73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
There were 96,338 attendances, a 1.4% decrease when compared to the previous month, December 2021
More than one in four patients were delayed by four hours or more
6,682 patients were delayed by eight hours or more, a 23% increase when compared to the previous month, December 2021
This is equal to 6.2% of all attendances
2,155 patients were delayed by 12 hours or more, a 30% increase when compared to the previous month, December 2021
This is equal to 2.1% of all attendances

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The health service in Scotland continues to face severe system pressures.

“Emergency Departments remain dangerously crowded with many patients facing extremely long waiting times as ambulances still face delays in offloading patients. These long waits are leading directly to harm for our patients.

“Despite the challenges of widespread bed shortages and staff shortages, Emergency Medicine staff continue to do all they can to keep patients safe. It is the hard work and dedication of EM staff who are preventing urgent and emergency care from tipping over the edge and falling deeper into crisis.

“Frontline workers continue to be pushed to their limit and are experiencing significant moral injury as a result of inadequate bed capacity and patient flow. It is clear that without significant, immediate change, both patients presenting to our Emergency Departments, and the staff working in them, face ongoing harm.

“Emergency Medicine staff will continue to be pushed to their limit unless an adequate urgent and emergency recovery plan is set out by the Scottish Government – this would prevent any threat of derailing elective care recovery.

“In the longer term, the Royal College continues to call for a fully funded long-term workforce plan and for 1,000 additional beds to be opened in the system. The current status quo is not sustainable for patients or staff, it is time to see meaningful action.”

Long waiting times continue to put patient safety at serious risk

The latest A&E activity and waiting times for major Emergency Departments in Scotland for December 2021 show:

73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
There were 97,644 attendances, a 6% decrease when compared to the previous month, November 2021
More than one in four patients were delayed by four hours or more
5,342 patients were delayed by eight hours or more, equal to 5.5% of all attendances
1,605 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “With fewer attendances performance has plateaued but be in no doubt that the health service and its staff in Scotland remain under unprecedented pressure and increasing burnout.

“One in four patients face delays over four hours, while both eight- and 12-hour waits are still at record high levels not seen before 2021. What is deeply concerning is the pattern and the potential for these long waiting times to become the status quo in perpetuity.

“Both our own report Crowding and its Consequences (below) and a recent article in the Emergency Medicine Journal ‘Association between delays to patient admission from the emergency department and all-cause 30- day mortality’ detail the real harm, and in some cases death, that long waiting times can cause patients.

“The impact of this continued poor performance is distress and moral injury to staff and serious discomfort and risk to the safety of patients. This must be an urgent signal and call to action for system change. We have long called on the government to open 1,000 more beds in the system in Scotland, and to commit to publishing a long-term workforce plan. While there remains an urgent need to address the social care crisis to help patients be discharged from hospital in a timely way.

“Quite simply things cannot continue as they are, more patients will come to harm and staff will face increasing distress at the quality of care they are or, more significantly, aren’t able to provide. The government must recognise the severity of the situation and the risk that continued poor performance, long waiting times, patient harm, and sinking quality of care will continue to spiral.”

RCEM_Why_Emergency_Department_Crowding_Matters Download

Choudhury: NHS Lothian ‘in crisis’

ANOTHER WEEK OF ‘SHOCKING’ A & E FIGURES RECORDED

Lothian MSP Foysol Choudhury has warned that NHS Lothian is in crisis as another week of dismal A&E figures has been recorded.

Statistics published yesterday show that only 64.8 per cent of attendances in NHS Lothian at A&E in the week ending 31st October were seen within four hours.

363 patients spent over eight hours in A&E, with 132 waiting over 12 hours.

1,504 patients waited over 4 hours.

These are among the worst weekly A&E times on record for NHS Lothian.

Scottish Labour MSP Foysol Choudhury said: “Yet another week of shocking statistics showing the reality of SNP mismanagement of our NHS.

“Lothian patients are in dire need of medical help and they are not receiving the swift attention they deserve. These are truly shocking figures that show once again just how out of depth the SNP Health Secretary Humza Yousef is.

“The SNP has left NHS doctors and nurses over-worked, under-staffed and under-resourced – and it is patients who are paying the price.’’

Waiting times: what’s happening?

During the pandemic, patients have been seen and treated based on their clinical urgency and we will continue to do so whilst we remobilise our NHS.

Patients are being classified in the following groups:

Priority Level 1a Emergency – operation needed within 24 hours
Priority Level 1b Urgent – operation needed within 72 hours
Priority Level 2 Surgery – scheduled within 4 weeks
Priority Level 3 Surgery – scheduled within 12 weeks
Priority Level 4 Surgery – may be safely scheduled after 12 weeks

NHS Scotland is working hard to increase the services available as safely and as quickly as possible. Clinicians and Clinical Experts are continuously reviewing how they deliver services to provide additional appointments to support your care.

About your appointment

It is important to attend your appointment or to let us know if you no longer need to attend.

Make sure you read any information provided in advance of your appointment so you know what to expect and can make the relevant preparations.

Keeping an eye on your condition

It is important to attend your appointment or to let us know if you no longer need to attend.

Make sure you read any information provided in advance of your appointment so you know what to expect and can make the relevant preparations.

Self Help

If you require further advice on your condition, please contact the hospital team you are awaiting an appointment with.

If your condition or symptoms worsen while waiting, you should contact your GP Practice.

Your local pharmacist or a trained member of the pharmacy team can give you advice and provide over-the-counter medicine if needed.

Call NHS 24 on 111 for further advice on managing symptoms.

If you consider your condition or symptoms to be life-threatening, then you should call 999 immediately.

Other Support

If you’re feeling overwhelmed, or that your mental health and well-being has been affected by the delay in your treatment, you can call:

NHS 24 on 111, 24 hours a day, and select the Mental Health option from the telephone prompts
Breathing space on 0800 83 85 87 is open weekdays Monday-Thursday, 6am to 2am, and weekends Friday 6pm to Monday 6am
Living Life on 0800 328 9655 is open Monday-Friday 1pm to 9pm

Your rights and responsibilities

Under the Charter of Patients Rights and Responsibilities, you have certain rights and responsibilities when using the NHS in Scotland.

For waiting times, It’s important that these be respected if patients are to receive treatment in the shortest time possible.

Your rights and responsibilities apply to waiting times in the following ways:

Availability
Appointments
Attendance

Find out more about how your rights and responsibilities apply to waiting times.

Lowest ever levels of A&E performance show NHS ‘near boiling point’

‘the reality is that the NHS is really struggling’

Responding to the latest set of performance figures released by NHS England for July 2021, President of the Royal College of Emergency Medicine, Dr Katherine Henderson, said: “The NHS has been running hot for months now and these figures show we are nearly at boiling point.

“We are worried that the public think that things are getting back to normal on the virtual eve of a further reduction in restrictions, and messages from the centre that says things are OK are disingenuous – the reality is that the health service is really struggling.

“Four-hour performance has sunk to its lowest ever level, we have levels of 12 hour waits we would usually associate with winter, and July saw the second highest ever number of attendances across emergency care units. Yet there is no sign of rescue ahead of winter. Despite our calls for action, crowding is back with us and is compromising patient care.”

Performance figures for Emergency Care for the NHS in England in July 2021 showed that:

there were 1,431,499 attendances at major Emergency Departments – the second highest on record
67.7% of patients waited less than four hours from arrival to admission, transfer, or discharge in Type 1 EDs – the lowest percentage on record
the number of patients waiting more than four hours after a decision to admit them stood at 89,768 – this is a 30% increase compared to June 2021 (66,619) and is the third highest ever
the number of patients waiting more than 12 hours after a decision to admit them stood at 2,215 – by far the highest July figure on record (second highest is 451 from July 2019).

Dr Henderson said: “The NHS was in a pretty dreadful state going into the pandemic – we were seeing record waits across the board, due to insufficient resourcing – but the sheer determination of an overstretched workforce, combined with a ‘whatever it takes’ approach, got us through.

“The problems that were with us before the pandemic have not gone away. Not only do they remain but are now much worse due to the impact of Covid, as these figures make crystal clear.

“The ambulance service saw thehighest ever number of ambulance callouts for life threatening conditions in July, and we saw ‘trolley waits’ in hospitals go up by 30% on the previous month. This means there have been delays offloading ambulances and patients have experienced long waits to be seen and moved to a bed if they need admission.

“Emergency Departments are very, very busy.

“There has also been a steady rise in Covid presentations and even though numbers are still low all the infection risk concerns remain in hospitals, further depleting capacity. Staff have had no let up and are worried about what the winter will be like if this is where we are in the summer.

“Demand is driven by multiple factors – difficulties accessing primary care, complications of chronic conditions, new presentations of significant illness and waiting list patients with on-going symptoms and no sign of getting their care sorted any time soon.

“NHSE recommends patients to access help via 111 but unless the system is responsive and clinically supported and other options available that advice too often defaults to go to the Emergency Department. Local health systems must ensure adequate urgent care facilities for their communities, letting Emergency Department have capacity to treat the seriously ill and injured.

“The other side of this is problems with supply – we do not have enough staff, beds, or equipment. There is still no plan for social care, which has a huge impact on the NHS. These have been issues for some time, but on top of this is the growing waiting list for elective care, staff absence due to a combination of leave and necessary self-isolation, and an even lower bed capacity due to infection prevention control measures.

“We fear for what winter may hold; we know it will be worse than now but a heavy flu season, another potential Covid surge and an understandable desire not to cancel elective care this winter could cripple us and put patient safety at risk.

“NHS Trusts must do all that they can to wring out every drop of capacity ahead of winter and the Department of Health and Social Care must extend ‘discharge to assess’, which made a significant difference freeing up beds during the pandemic. There has been a sustained rise in the number of patients experience long stays in hospital, and this funding is critical to freeing beds and maintaining flow in hospitals.

“We also need clarity in terms of performance – we are currently in a performance vacuum with Trusts uncertain about what they need to focus on. Implementing some of the metrics proposed by the Clinical Review of Standards is vital ahead of winter. We need to operationalise the metric of a maximum of a 12 hour stay from point of arrival. This will be a small step to reducing exit block, and allow timely ambulance offloads.

“While the NHS rollout of the vaccine has been an incredible success, parliament must not take its eyes off the ball regarding the state of the NHS. This autumn’s spending review – one which has not been put out to consultation – is an opportunity for the government to further signal it’s ‘peace time’ commitment to NHS funding and help prevent the NHS from boiling over this winter.”

The situation in Scotland is also giving cause for alarm. Lothian MSP, Miles Briggs is ‘very concerned’ A&E waiting times aren’t showing signs of improvement.

Miles Briggs MSP said: “NHS Lothian is in desperate need of an injection of funds to alleviate pressure on services.

“Years of chronic underfunding and a global pandemic has left staff on their knees, struggling to meet the increased numbers of patients attending A&E.

“SNP Ministers must take responsibility for allowing the situation to get to this point and immediately fund NHS Lothian properly to start getting services back to normal.”

https://www.publichealthscotland.scot/publications/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics-week-ending-1-august-2021/

Scotland’s Emergency Departments experience worst ever May performance

The latest data released yesterday by the Scottish Government for May 2021 show that attendances at Emergency Departments have risen significantly.

In May 2021 there were 112,563 attendances to major Emergency Departments across Scotland. This is a 12% increase compared to April 2021, a 24% increase when compared to March 2021, and a 45% increase compared to May 2020.

Following this increase, four-hour performance deteriorated, 86% of attendances to major Emergency Departments in Scotland were seen within four hours. 15,706 patients were delayed by four-hours or more in an Emergency Department, this is the highest figure since January 2020, and it is the highest figure ever recorded for the month of May. This means one in seven patients were delayed by four hours or more before being seen.

In May 2021, 393 patients spent 12 hours or more in an Emergency Department, this is double the figure for April 2021. This is the highest number of 12-hour delays for the month of May ever recorded, and it is more than double the previous highest May figure of 189 12-hour delays that was recorded in 2019.

Data also show that 1,680 patients spent eight hours or more in a major Emergency Department, this is an increase of nearly 50% compared to April 2021 and it is the highest figure ever recorded for the month of May.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine, said: “The data is deeply concerning and very much reflects what is happening on the ground. Departments are busier than ever, especially for the summer period with some record-breaking figures for the month of May, and it is becoming increasingly challenging.

“These figures come at a time when reports suggest Scotland has the highest covid infection rate in Europe. We are battling community admissions, elective care patients seeking treatment, as well as increasing covid patients attending our departments, all within the context of reduced bed-stock.

“Departments are filled with patients, some who may have covid, waiting to be seen. While long-stays alone can put patient safety at risk. This risk is increased as some patients could contract the disease in a busy Emergency Department.

“The College’s recent Emergency Medicine workforce census in Scotland revealed an Emergency Medicine workforce that was not adequately staffed to deliver the highest quality patient care in Emergency Departments in Scotland.

“We have shortages across the board, but particularly among consultants and senior decision-making clinicians. These shortages are currently exacerbated by the soaring covid infection rate, meaning there are a large number of absent NHS staff due to covid in Scotland.

“We are doing all we can to maintain flow and maximise patient safety, but the pressures are increasingly intense and are faced by the existing but short-staffed workforce that are facing continued burnout and exhaustion.

“The data show the growing demand for urgent and emergency care, Emergency Departments are where people turn to for treatment when there is nowhere else to go, so they must be adequately staffed with trained Emergency Medicine staff, properly funded, and equipped with enough capacity and resources to cope with severe demand.”

“We urgently need the Scottish Government to support the urgent and emergency care system to cope with these pressures.”

Two NHS Grampian hospitals have announced this week that they are at capacity as Covid cases rise.

Scotland was expected to move to level zero on 19 July, with remaining legal restrictions lifted on 9 August, but First Minister Nicola Sturgeon conceded yesterday that th planned dates are not “set in stone”.

She will be holding a media briefing at lunchtime today:

Royal College of Emergency Medicine: Winter crisis looming?

16,000 additional beds may be needed for the NHS to cope this winter

The NHS urgently needs a rapid increase in bed numbers if it is to meet potential demand this winter according to new analysis from the Royal College of Emergency Medicine.

The College’s new briefing document ‘RCEM Explains: Hospital Beds’ looks at how bed numbers have declined in the past decade, the impact of covid, and the potential number of beds needed this winter, based on previous levels of demand.

The briefing uses the ratio of emergency admissions to beds to model the numbers of beds that will likely be needed, based on the levels of demand seen each winter prior to the pandemic.

In the last five years in England this figure has fluctuated between 11.07 admissions per bed (winter 2015/16) and 12.50 (winter 2018/19). Excluding the most recent winters (both of which saw demand and capacity fall due to the pandemic), there was an average of 11.77 admissions per bed.

If the NHS is to achieve a similar ratio this winter, and there are a similar number of admissions as in the winter of 2017/18, the NHS will need just over 7,500 additional beds. If demand is similar to 2018/19, then this figure rises to 15,788 extra beds.

President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “We are currently seeing record levels of attendances at Emergency Departments and if this continues into winter – an extremely likely situation – the NHS will have too few beds to be able to cope.

“The consequences of having too few beds could be dire. If we do not have the capacity to admit patients into hospitals, then A&E waiting times will go up, patients will end up being treated in corridors – a very real threat to their safety before the pandemic, but now with the added risk of hospital acquired infection – and the elective backlog will grow further as beds earmarked for surgeries will be used for emergency patients.”

The briefing also makes clear the relationship between high bed occupancy and an increased rate of cancelled elective operations.

Dr Henderson said: “Too few beds means higher rates of occupancy, which in itself puts patient safety at risk, but it is clear that this has a huge knock-on effect on elective care. Lack of beds is one of the top reasons for cancellation of surgeries and if we do not address the shortage now, before winter, the elective recovery will fail.

“We know that access to services is an issue throughout the NHS at the moment with resources short all-round, but Emergency Departments act as the safety net for the NHS – if they cannot function properly the entire system stalls – so it is vital that the new Secretary of State does all he can to enable the NHS to expand hospital capacity.

“The safe restoration of bed capacity to pre-pandemic levels is no easy fix though – as we’ve seen with the Nightingale initiative, capacity cannot be expanded if we do not have enough doctors, nurses, and clinicians.

“The capacity and staffing issues we face now have been over a decade in the making. Social care is still unfixed. Waiting lists are growing. Structural reconfiguration is in progress. Covid is less of an immediate threat but is unlikely to disappear. The Secretary of State has much to do, but he must start by making the beds.”

Briggs: NHS Lothian has longest outpatient waiting times in Scotland

Lothian Conservative MSP Miles Briggs said: “Every health board in Scotland has been significantly impacted by Covid-19, but none more than NHS Lothian.

“Consecutive years of chronic underfunding for NHS Lothian by SNP Ministers has meant that the health boards was the least prepared for Covid-19, with lengthening waiting times pre Covid-19.

“A recovery plan to restore performance targets will be important across Scotland, but especially for NHS Lothian and the formula for funding health boards needs urgently reviewed.

“It is time for NHS Lothian to receive their fair share of funding, so that patients in Edinburgh and the Lothian’s don’t have to suffer exceptionally long waiting times for treatments.”

https://beta.isdscotland.org/find-publications-and-data/healthcare-resources/waiting-times/nhs-waiting-times-stage-of-treatment/

Child mental health services: Coalition calls for national crusade

The Scottish Children’s Services Coalition (SCSC), an alliance of leading independent and third sector providers of children’s services, has warned of a mental health “perfect storm” for children and young people. It has also called for a “national crusade” to tackle this.

The warning comes on the back of figures from Public Health Scotland which indicate that the number of referrals to child and adolescent mental health services (CAMHS) has dropped by a staggering 55.8 per cent between quarters January and March 2020 and April and June 2020 (from 9,017 to 3,985). ¹

These range from a 66.7 per cent fall in referrals for NHS Dumfries and Galloway to 7.7 per cent in NHS Orkney (full table in Notes to Editors).

It also highlights that in June 2020, 1,136 children and young people had been waiting more than a year for treatment, up from 581 on the same point last year.²

The SCSC has warned that mental health services will face an overwhelming and unprecedented pressure due to pent-up demand created by the COVID-19 lockdown, coupled with a cut in youth support services. This could potentially lead to a “lost generation” of vulnerable children and young people who are missing out on the support they vitally need.

It has called for a “national crusade”, with the Scottish Government working closely with authorities, including the third and independent sectors, and investing significantly in mental health services. The coalition has also urged that greater awareness is made of the services on offer, especially those at a community level.

The SCSC has warned that self-isolation and social distancing have had an impact on young people struggling with issues such as anxiety and depression. It has noted that even the most resilient children are going to need additional support as they navigate this transition back into whatever is the new normal, and some will need a lot of extra support.

A report commissioned by Young Scot, YouthLink Scotland and the Scottish Youth Parliament, called Lockdown Lowdown, found almost two-fifths of young people felt moderately or extremely concerned about their own mental wellbeing.³

A spokesperson for the SCSC commented: “These latest figures are deeply troubling and point to a ‘perfect storm’ for our young people, with increased demand coupled with cuts in services.

“While referrals have dropped during lockdown and children are not accessing support, we are storing up immense problems for the future as specialist mental health services face being overwhelmed due to greatly increased demand.

“We need a ‘national crusade’ to deliver the mental health provision our young people desperately need. The Government needs to work urgently with the relevant authorities to ensure that not only is there sufficient provision available at the local community level, but that this is clearly communicated and easily accessible for young people and their parents or carers.

“It is not just the NHS, but the third sector and other independent organisations play a key role in addressing mental health services and must receive the funding they vitally need or we face a ‘lost generation’ of vulnerable children and young people.”

Six out of ten young people waiting over 18 weeks to be seen in Lothian

The number of children and young adults waiting over 18 weeks to be seen by a mental health professional has increased to 147 out of 247 patients seen, 59.5%, In June 2020 the latest month of statistics available.

As of June 2020 there are 2,482 young people waiting to be seen in Edinburgh and the Lothians, with a record 472 waiting for over a year, 19% of total waits.

In April to June 2020 there were 825 CAMHS referrals, with 109 rejected, making a total of 706 new referrals. This is compared to 1,659 referrals in January to March 2020, with 382 referrals rejected, making a total of 1277 new referrals.

Lothian MSP, Miles Briggs, said: “These figures reinforce the mental health crisis for young people in NHS Lothian with exceptionally long waits to be seen by a mental health professional.

“Mental Health professionals in NHS Lothian work incredibly hard to support young people who are struggling with their mental health, but services are simply not being properly resourced to meet demand.

“Lockdown, Covid-19 restrictions and failures by SNP Ministers over SQA results will all have added to stresses for young people making mental health support even more important.
“SNP Ministers have presided over our health service for over 13 years and have failed to support a generation of young people.”

¹NHS Information Services Division, Child and Adolescent Mental Health Services Waiting Times in Scotland – Full report (PDF link), 1^st September, Table 5, Available at: https://beta.isdscotland.org/find-publications-and-data/conditions-and-diseases/mental-health/child-and-adolescent-mental-health-services-camhs-waiting-times/ (accessed 1^st September 2020).

²Ibid., waiting times table 1b

³Young Scot, YouthLink Scotland and the Scottish Youth Parliament, Lockdown Lockdown – what young people in Scotland are thinking about COVID-19 (PDF), 23rd April 2020. Available at: https://www.youthlinkscotland.org/media/4486/lockdown-lowdown-final-report.pdf (accessed 11th August 2020).